Regular follow-ups key to reducing eclampsia rates, maternal mortality

Regular monitoring of expecting mothers can help reduce maternal death rates from eclampsia in the country, say experts.

In 2020, eclampsia accounted for 6.0 percent of maternal deaths in Malaysia, making it the fourth highest cause of maternal death after obstetric embolism, postpartum haemorrhage, and gestational hypertension with significant proteinuria.

Clinical signs of preeclampsia include hypertension and signs of organ damage, most often renal, as indicated by proteinuria. These are related to abnormal blood vessel formation in the placenta and maternal blood vessels, though the underlying cause of these abnormalities remains unknown.

According to consultant obstetrician and gynaecologist Dr Nor Elyana Noordin, preeclampsia generally occurs during the antenatal period, particularly the third trimester. Eclampsia is a severe complication from untreated preeclampsia, manifesting as the onset of seizures or fits.

“Eighty percent of eclamptic fits occur during the delivery process, or within the first 48 hours following delivery. Statistically speaking, the prevalence of preeclampsia and eclampsia is 4.6 percent and 0.3 percent, respectively,” said Nor Elyana.

Preeclampsia may also restrict the foetal blood supply, causing foetal growth restriction during the gestation period, according to Dr Wong Yen Shi, a consultant obstetrician and gynaecologist. Wong added that a woman has a 15 percent chance of developing preeclampsia in her second pregnancy if she experienced it in her first.

“Preeclampsia and its complications increase the likelihood of preterm delivery. The complications that follow preterm deliveries may include cerebral palsy (irreversible movement disorder), learning disabilities, feeding or gut problems, and visual or hearing impairment,” said Wong.

Major risk factors for preeclampsia include diabetes, existing hypertension or kidney disease before pregnancy, and autoimmune conditions such as lupus or antiphospholipid syndrome (APS).

Other known risk factors include first time pregnancy, family history of preeclampsia, older age (>40 years), a 10-year gap from last pregnancy, multifoetal gestation, or BMI ≥35.

Tackling a maternal killer

The family physician can play a key role in early diagnosis and intervention; patients should be encouraged to attend obstetric check-ups consistently and disclose any new symptoms. While preeclampsia may develop asymptomatically, any incidences of hypertension in pregnancy should be of concern.

“Pregnant ladies with preeclampsia have to be monitored closely through regular blood pressure monitoring, serial blood investigations and urine protein tests to ensure the wellbeing of both mother and baby,” said Nor Elyana. “If blood pressure is uncontrolled even with optimal medications, or there are abnormal blood parameters, the baby has to be delivered so that preeclampsia does not worsen and progress to eclampsia.”

Other potential symptoms of severe preeclampsia include severe headaches, vision problems, pain below the ribs, severe nausea and vomiting, sudden weight gain and swelling (oedema) in the face and hands.

Delivery remains the definitive treatment for eclampsia, but in cases of preterm pregnancy, treatment focuses on pharmacological control of hypertension and closely monitoring the condition of mother and child, said Wong.

“If the pregnancy has reached 37 weeks or more, delivery may be warranted via induction of labour or caesarean section. Mothers who have not reached 37 weeks but have developed preeclampsia complications need immediate delivery,” she added.

While lifestyle modifications can help reduce odds of preeclampsia, women with underlying hypertension should generally focus on managing it prior to considering pregnancy, Wong advised.